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NPI Code Detail

MEDICARE: M GANJIANPOUR, M.D. A PROFESSIONAL CORPORATION

MEDICARE: M GANJIANPOUR, M.D. A PROFESSIONAL CORPORATION
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1174400000XSpecialistA71028CA

General Provider Information

NPI Number : 1770806184
Entity Type Code : Organization
Provider Name (Legal Business Name) : M GANJIANPOUR, M.D. A PROFESSIONAL CORPORATION
Provider Business Mailing Address
First Line : 6330 SAN VICENTE BLVD
Second Line : SUITE 310
City : LOS ANGELES
State : CA
Zip : 90048-5425
Country : US
Telephone Number : 310-855-0751
Fax Number :
Provider Business Practice Location Address
First Line : 6330 SAN VICENTE BLVD
Second Line : SUITE 310
City : LOS ANGELES
State : CA
Zip : 90048-5425
Country : US
Telephone Number : 310-855-0751
Fax Number :
Authorized Official
Title or Position : MEDICAL DOCTOR
Name : DR. MARK GANJIANPOUR
Credential :
Telephone Number : 310-855-0751
Provider Enumeration Date : 03/12/2010
Last Update Date : 01/31/2014

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